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Imatinib

Leukemia Insights - Fall 2008

The standard dose of imatinib for patients in chronic phase is 400 mg daily.4

Approximately 40% of patients in chronic phase who fail to respond to the standard dose may respond when their dose is increased to 800 mg daily. Some single-arm phase II studies have suggested that higher doses of imatinib (i.e., 600 to 800 mg daily) used as the starting dose for patients in chronic phase may result in improved responses.5-8 Using this higher dose, over 90% of patients have achieved a complete cytogenetic response and approximately 50% have achieved undetectable levels of Bcr-Abl by PCR (i.e., “complete” molecular response).

Responses occur significantly faster with higher doses. Higher doses are well tolerated in most patients and over 80% of patients have continued receiving high higher with high-dose imatinib. Most important, event-free survival and survival free from transformation to accelerated or blastic phases were significantly superior with high-dose imatinib as initial therapy. Randomized studies of high-dose versus standard dose imatinib are ongoing and early results have confirmed the earlier achievement of cytogenetic and molecular responses. Currently imatinib 400 mg daily is the standard of care; high-dose imatinib should be considered for patients with suboptimal response, and could also be considered for patients with cytogenetic relapse on standard dose imatinib. dose imatinib after 12 months of therapy.

In the most recent update of our experience with high-dose imatinib, the rate of complete cytogenetic responses was significantly higher with high-dose compared to a historical population treated with standard-dose imatinib (91% vs 78%; p=0.03). The rate of major and complete molecular responses was also significantly higher with high-dose imatinib. Most important, event-free survival and survival free from transformation to accelerated or blastic phases were significantly superior with high-dose imatinib as initial therapy. Randomized studies of high-dose versus standard dose imatinib are ongoing and early results have confirmed the earlier achievement of cytogenetic and molecular responses. Currently imatinib 400 mg daily is the standard of care; high-dose imatinib should be considered for patients with suboptimal response, and could also be considered for patients with cytogenetic relapse on standard dose imatinib.


© 2014 The University of Texas MD Anderson Cancer Center